In medical practice, there are cases in which there is a potential opportunity to restore the most important functions of the human body. This necessitated the development of a specific scheme of action, which can promote revitalization. Next, we will consider what a complex of resuscitation measures is.
There is a specific section of medicine that studies resuscitation. Within the framework of this discipline, various aspects of human recovery are explored, methods for the prevention and treatment of terminal conditions are being developed. This section of clinical medicine was called resuscitation, and the direct application of various methods of recovery is called resuscitation.
When are the methods of revitalization used?
There are various cases when methods of restoring vital functions are necessary. So, reanimation measures are used when cardiac arrest (against a background of a heart attack, due to electric trauma, etc.), breathing (when the foreign body blocks the trachea, etc.), poisons poisoning. Helping a person is necessary in case of great blood loss, acute kidney or liver failure, serious injuries and so on. Very often the time of resuscitation is very limited. In this regard, the actions of the provider should be clear and fast.
In some cases, resuscitation is inappropriate. In particular, such situations include irreversible damage to vital systems and organs, in the first place - the brain. Resuscitative measures for clinical death are ineffective after 8 minutes after its detection. Rejuvenation techniques are not used if the available compensatory resources of the body have been exhausted (for example, against the background of malignant tumors that occur with general exhaustion). The effectiveness of resuscitation is significantly increased when implemented in specialized departments that are equipped with the necessary equipment.
These include heart massage and artificial respiration. The latter is a procedure for replacing air in the victim's lungs. Artificial ventilation facilitates the maintenance of gas exchange in case of inadequate or inability to breathe naturally. Heart massage can be direct and closed. The first is carried out by direct compression of the organ. This method is used in the course of operations in the chest area when the cavity is opened. Indirect massage is the squeezing of the organ between the sternum and the spine. Let's consider these resuscitation measures in detail.
Artificial respiration: general information
The need for ventilation occurs in the case of violations of regulatory centers against the background of edema or circulatory disorders in the brain. The procedure is carried out with the defeat of nerve fibers and muscles participating in the act of breathing (poliomyelitis, tetanus, poisons), severe pathologies (extensive pneumonia, asthma and others). It is widely practiced to provide resuscitation activities using hardware methods. The use of automatic respirators allows maintaining gas exchange in the lungs for a long period. The ventilation of the lungs - as a measure of emergency care - is treated against a background of such conditions as drowning, asphyxiation (choking), shock (solar or thermal), electric injury, poisoning. In such cases, artificial respiration is often resorted to using expiratory methods: from the mouth to the mouth or into the nose.
Passage of the respiratory tract
This indicator is the most important condition for effective air ventilation. In this regard, before applying expiratory methods, it is necessary to ensure free air permeability through the respiratory tract. Ignoring this action leads to ineffectiveness of ventilation of the lungs by mouth-to-mouth or nose. Bad patency can often be due to the stigma of the epiglottis and the root of the tongue. This, in turn, is due to the relaxation of the masticatory muscles and the displacement of the lower jaw in the unconscious state of the patient. To restore the patency of the head of the victim tilt as much as possible - unbend in the vertebral-occipital articulation. Thus the lower jaw is pushed so that the chin is in a more elevated position. For the epiglottis through the throat, the injured person is injected with a curved airway.
There is a certain sequence of resuscitation measures to restore normal breathing in the victim. The person must first be laid on his back horizontally. The abdomen, thorax and neck are released from the restraining clothes: untie a tie, unbutton the belt, collar. The mouth cavity of the victim must be freed from vomit, mucus, saliva. Then, putting one hand on the top of the head, the second is brought under the neck and tilts the head. In the event that the jaws of the victim are strongly squeezed, the lower one is pulled out by pressing the index fingers on its corners.
If artificial respiration is carried out from the mouth to the nose, then the victim's mouth should be closed, lifting the lower jaw. The man of relief, taking a deep breath, clasps the nose of the patient with his lips and exhales vigorously. When using the second method, the actions are somewhat different. If artificial respiration is carried out in the mouth, then the nose of the victim is closed. An exhalation of the helper carries out into the mouth, covered with a handkerchief. After this, passive air release from the patient's lungs should occur. For this, his mouth and nose are slightly opened. During this time, the caretaker takes his head to the side and does 1-2 normal inhalations. Criterion for the correctness of the manipulations are excursions (movements) of the chest of the victim during the artificial inspiration and with a passive expiration. In the absence of movements, the causes should be identified and eliminated. This may be insufficient patency of paths, a small amount of blown air flow, as well as a weak seal between the nose / mouth of the victim and the mouth of the caregiver.
Within one minute, on average, 12-18 artificial breaths are needed. In emergency cases, ventilation is carried out using "hand-held respirators." For example, it can be a special bag, which is presented in the form of a rubber self-expanding camera. It has a special valve, which ensures the separation of the incoming and passively exiting airflow. With proper use in this way, gas exchange can be maintained for a long period.
Massage of the heart
As was said above, there is a direct and indirect method of restoring the activity of the organ. In the latter case, due to the compression of the heart between the spine and the sternum, blood flows into the pulmonary artery from the right ventricle, and from the left one into the large circle. This leads to the restoration of nutrition of the brain and coronary vessels. In many cases this contributes to the resumption of heart activity. Indirect massage is necessary if the organ contractions suddenly stop or worsen. This may be cardiac arrest or ventricular fibrillation in patients with electric trauma, heart attack and others. When determining the need for indirect massage, you should focus on a number of symptoms. In particular, resuscitation is carried out with a sudden cessation of breathing, the absence of a pulse on the carotid artery, dilated pupils, loss of consciousness, the development of pallor of the skin.
As a rule, massage, started in the early period after stopping or worsening of the heart, is very effective. Of great importance is the period after which the manipulations are started. So, resuscitation at a clinical death, carried out immediately after its onset are more effective than actions after 5-6 minutes. Correctly executed manipulations allow to restore activity of an organ rather quickly. As in other cases, there is a definite sequence of resuscitation measures. Knowledge of the technique of performing indirect heart massage will allow people to save their lives in emergency situations.
Before carrying out resuscitation, the victim should be placed on a hard surface on his back. If the patient is in bed, then, in the absence of a rigid couch, he is shifted to the floor. The victim is released from the outer clothing, remove the strap. An important point is the correct position of the hands of the reanimator. The palm is placed on the lower third of the chest, the second is placed on top. Both hands should be straightened at the elbow joints. The limbs are perpendicular to the sternum. Also the palms should be in the maximally straightened state in the wrist joints - with raised fingers. In this position, the pressure on the sternum in the lower third of it is carried out by the initial portion of the palm. Pressures represent rapid tremors in the sternum. To spread it, the hands are taken from the surface after each pressing. The strength needed to move the sternum to 4-5 cm is provided not only by hands, but also by the weight of the reanimator. In this regard, if the victim is lying on a couch or bed, then the provider should stand on the stand. If the patient is on the ground, then the reanimator will be more comfortable on his knees. The frequency of pressure is 60 strokes per minute. With a parallel massage of the heart and ventilation of the lungs by two people, 4-5 tremors in the sternum are carried out for one inhalation, 1 person - 2 inhalations for 8-10 squeezes.
The effectiveness of manipulation is checked at least once a minute. It is necessary at the same time to pay attention to the pulse in the carotid arteries, the state of the pupils and the presence of independent breathing, increasing blood pressure and reducing cyanosis or pallor. In the presence of appropriate equipment, resuscitation is supplemented by intracardiac infusion of 1 ml of 0.1% adrenaline or 5 ml of a 10% solution of calcium chloride. In a number of cases, the restoration of the contractile capacity of the organ can be achieved with a sharp blow to the fist at the center of the sternum. When a ventricular fibrillation is detected, a defibrillator is used. The cessation of resuscitation takes place 20-25 minutes after the beginning of the resuscitation if there are no results of manipulation.
The most common consequence of an indirect heart massage is a fracture of the ribs. It is most difficult to avoid this in the elderly because their chest is not as flexible and elastic as in young patients. Less frequent damage to the lungs and heart, ruptures of the stomach, spleen, liver. These complications are the result of technically incorrect manipulation and dosing of physical pressure on the sternum.
This period is considered a stage of dying and is reversible. It is accompanied by the disappearance of external manifestations of the vital activity of man: breathing, contractions of the heart. But thus there are no irreversible changes in tissues and organs. Typically, the duration of the period is 5-6 minutes. During this time with the use of resuscitation can restore life. At the end of this period, irreversible changes begin. They are defined as a state of biological death. In this case, it is not possible to achieve a complete restoration of the activities of organs and systems. The duration of clinical death depends on the duration and type of dying, body temperature, age. For example, when using artificial deep hypothermia (a decrease of t to 8-12 degrees), the period can be increased to 1-1.5 hours.